The NHS has confirmed its priorities and planning guidance for 2025/26. Systems gain financial flexibility but must cut costs by at least 1% and boost productivity by at least 4%.
- Continuation of payment for Elective activity on individual unit NHSPS prices
- Withdrawal of the proposed elective payment cap which would have allowed commissioners to limit payments on elective contracts
- Changes to the Activity Management Provisions of the NHS Standard Contract to assist commissioners in the management of variable activity (elective) to deliver elective performance targets (such as RTT) and balanced financial plans
- Requirement for Indicative Activity Plans (IAP), with commissioners able to set an IAP where one cannot be agreed between commissioner and provider
- Commissioners can require Activity Management Plans (AMP) and apply financial consequences included in the AMP to control activity within the limits of the IAP
- Continuation of Non-Elective activity funded under a fixed/block payment
- Fixed contract values are still heavily based on emergency payments agreed under COVID measures, subsequently adjusted for inflation etc.
What This Means For Coding at Your Trust
Financial
Maintaining high data quality is essential for efficient payment processes. Both providers and commissioners need to ensure that the clinically coded patient-level data submitted is accurate, complete, and suitable for the purposes of payment under the NHSPS.
- The price of elective activity is based on the clinical coding of each admission.
- Precise and thorough clinical documentation and coding are necessary for accurate income recovery, to ensure providers receive fair payment per case and avoid extra costs without correct reimbursement.
- Inaccurate coding would mean Providers could fall short of their expected income level even if indicative activity plans volume were precisely delivered, therefore missing out on available income. Alternatively, Providers could end up delivering more volume of activity to reach the activity plan value, thus incurring costs without accurate reimbursement
- Payments for non-elective activities will continue as fixed or block payments. In recent years, these payments have been largely influenced by emergency provisions during the Covid-19 pandemic, which may not accurately reflect current activity levels and associated costs. Starting from the financial year 2025/26, these contract values will need to be reviewed annually. Therefore, accurate and comprehensive clinical documentation and coding are essential to:
- Understand any variance between current fixed contract values and the value based on recorded coded activity and unit prices
- Demonstrate the true acuity and complexity and value of work performed, providing a strong negotiating position with ICBs for either future fixed payment contract values or in preparation should there be a return to activity based-payments in 2026/27
- Ensuring operational efficiency and resource needs for service delivery
- Ensure fair benchmarking against other Providers, and not negatively impacting future payment negotiations
Non-Financial
- Focusing on a 4% productivity improvement for 2025/26 relies on HRG4 weights for casemix complexity, making accurate coding crucial to avoid underreported productivity.
- Accurate coded activity data assures Boards of reliable data for service provision, quality, and planning.
- Inaccurate coding can misrepresent patient complexity, leading to higher-than-expected mortality rates, misleading clinical quality conclusions, unnecessary interventions by oversight bodies, and inappropriate quality improvement actions.
Maxwell Stanley is the leading clinical coding specialist in the NHS. Our Solution ensures accurate recovery of income and clinical outcome metrics, through a targeted and automated identification of admissions with incomplete or inaccurate clinical coding and documentation. We have a team of qualified clinical coding experts who can then support the review and amendment of the clinical coding to realise the benefits identified.
